术前炎性指标检测对老年急性阑尾穿孔的诊断价值
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摘要
目的探讨临床中常规炎性指标对老年患者急性阑尾穿孔的诊断价值。方法选取该院2017年1月至2018年10月收治的诊断为急性阑尾炎的老年患者,所有纳入患者年龄均高于60岁,根据患者术中诊断是否有阑尾穿孔将患者分为观察组(阑尾有穿孔,43例)和对照组(阑尾未穿孔,67例)。分析2组患者术前白细胞(WBC)、中性粒细胞比值(NEUTR)、红细胞分布宽度与血小板计数比值(RPR)、降钙素原(PCT)、C-反应蛋白(CRP)和总胆红素(TBIL)指标差异,分析影响老年患者阑尾穿孔的独立影响因素,进一步分析其独立影响因素对老年患者阑尾穿孔的诊断效能。结果观察组患者WBC、NEUTR、RPR、PCT、CRP和TBIL均高于对照组,差异有统计学意义(P<0.01)。多因素分析结果显示,RPR、PCT、CRP是阑尾穿孔的独立危险因素(P<0.05)。以73.65 mg/L为截点值,CRP敏感性为83.06%,特异性为80.40%,曲线下面积为0.847,优于PCT和RPR(71.64%、76.07%和59.21%、67.44%)。结论 CRP在老年患者急性阑尾穿孔中具有良好的辅助诊断价值,在老年腹部体征不明显者中具有良好的应用价值。
Objective To explore the diagnostic value of routine inflammatory markers in elderly patients with acute appendiceal perforation.Methods The elderly patients diagnosed with acute appendicitis admitted to the hospital from January 2017 to October 2018 were selected.All patients were older than 60 years old.According to the patient intraoperative diagnosis of whether had appendiceal perforation,43 patients with appendiceal perforation were included in the observation group,67 patients without appendiceal perforation were included in the control group.The difference of preoperative white blood cells(WBC),neutrophil percentage(NEUTR),red blood cell distribution width and platelet count ratio(RPR),procalcitonin(PCT),C-reactive protein(CRP)and total bilirubin(TBIL)index in two groups were analyzed.The independent influencing factors on the appendiceal perforation in elderly patients were analyzed.Further analyzed of the diagnostic efficacy of independent influencing factors on appendiceal perforation in elderly patients.Results The WBC,NEUTR,RPR,PCT,CRP and TBIL of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.01).Multivariate analysis showed that RPR,PCT and CRP were independent risk factors for appendiceal perforation(P<0.05).With the cut off point of 73.65 mg/L,the sensitivity of CRP in predicting appendiceal perforation in elderly patients was 83.06%,the specificity was 80.40%,and the area under the curve was 0.847,which were better than PCT and RPR(71.64%,76.07%and 59.21%,67.44%).Conclusion CRP has a good diagnostic value in acute appendiceal perforation in elderly patients,and it has good application value in elderly patients with inconspicuous abdominal signs.
Objective To explore the diagnostic value of routine inflammatory markers in elderly patients with acute appendiceal perforation.Methods The elderly patients diagnosed with acute appendicitis admitted to the hospital from January 2017 to October 2018 were selected.All patients were older than 60 years old.According to the patient intraoperative diagnosis of whether had appendiceal perforation,43 patients with appendiceal perforation were included in the observation group,67 patients without appendiceal perforation were included in the control group.The difference of preoperative white blood cells(WBC),neutrophil percentage(NEUTR),red blood cell distribution width and platelet count ratio(RPR),procalcitonin(PCT),C-reactive protein(CRP)and total bilirubin(TBIL)index in two groups were analyzed.The independent influencing factors on the appendiceal perforation in elderly patients were analyzed.Further analyzed of the diagnostic efficacy of independent influencing factors on appendiceal perforation in elderly patients.Results The WBC,NEUTR,RPR,PCT,CRP and TBIL of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.01).Multivariate analysis showed that RPR,PCT and CRP were independent risk factors for appendiceal perforation(P<0.05).With the cut off point of 73.65 mg/L,the sensitivity of CRP in predicting appendiceal perforation in elderly patients was 83.06%,the specificity was 80.40%,and the area under the curve was 0.847,which were better than PCT and RPR(71.64%,76.07%and 59.21%,67.44%).Conclusion CRP has a good diagnostic value in acute appendiceal perforation in elderly patients,and it has good application value in elderly patients with inconspicuous abdominal signs.
引文
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[7]郭志芳,王江平,耿华雄,等.腹腔镜与开腹阑尾切除术治疗穿孔性阑尾炎的效果比较[J].中国基层医药,2015,22(18):2727-2728.
[8]朱长富,侯秀昆,陶冶,等.急诊超声诊断老年急腹症的临床应用及误诊原因[J].中国老年学杂志,2016,36(12):3011-3012.
[9] TANRIKULU Y,YILMAZ G,SEN TANRIKULU C,et al.A prospective clinical study of the effects of the physical features of the appendix on perforation[J].Ulus Travma Acil Cerrahi Derg,2015,21(6):440-445.
[10]蔡仲达,谢尚锦,蔡和杰.老年患者消化道穿孔的临床诊治探讨[J].中国现代普通外科进展,2016,19(12):978-980.
[11]ZBIERSKA K,KENIG J,LASEK A,et al.Differences in the clinical course of acute appendicitis in the elderly in comparison to younger population[J].Pol Przegl Chir,2016,88(3):142.
[12]赵民学,朱琳叶,洪珊,等.单孔腹腔镜阑尾切除术治疗老年急性阑尾炎的疗效[J].中国老年学杂志,2015,35(24):7126-7127.
[13]艾猛,秦立国.腹腔镜治疗老年阑尾炎的临床疗效分析[J].中国医药指南,2016,14(28):52.
[14]包翔宁,陈涛,张宗权.多项指标联合检测在急性阑尾炎诊疗中的价值探讨[J].国际检验医学杂志,2016,37(5):668-670.
[15]GEE M,ADAMS H,JAUNOO S,et al.Hyperbilirubinaemia in appendicitis:the diagnostic value for prediction of appendicitis and appendiceal perforation[J].British J Surg,2015,102(1):229.
[2]倪航航,梁志宏,刘书强,等.预测急性坏疽性阑尾炎的危险因素分析[J].临床外科杂志,2017,25(8):625-627.
[3] OMARI AH,KHAMMASH MR,QASAIMEH GR,et al.Acute appendicitis in the elderly:risk factors for perforation[J].World J Emerg Surg,2014,9(1):1-6.
[4]华科俊,胡贤杰,张星,等.炎性指标在阑尾炎穿孔诊断中的价值研究[J].中国全科医学,2017,20(17):2139-2142.
[5] ZOGG CK,SCOTT JW,JIANG W,et al.Differential access to care:the role of age,insurance,and income on race/ethnicity-related disparities in adult perforated appendix admission rates[J].Surgery,2016,160(5):1145-1154.
[6]?IFTCI F,ABDURRAHMAN I,EREN A.A rare cause of acute abdominal disease:two reports of caecal diverticulum perforation[J].Ulus Travma Acil Cerrahi Derg,2016,22(3):290.
[7]郭志芳,王江平,耿华雄,等.腹腔镜与开腹阑尾切除术治疗穿孔性阑尾炎的效果比较[J].中国基层医药,2015,22(18):2727-2728.
[8]朱长富,侯秀昆,陶冶,等.急诊超声诊断老年急腹症的临床应用及误诊原因[J].中国老年学杂志,2016,36(12):3011-3012.
[9] TANRIKULU Y,YILMAZ G,SEN TANRIKULU C,et al.A prospective clinical study of the effects of the physical features of the appendix on perforation[J].Ulus Travma Acil Cerrahi Derg,2015,21(6):440-445.
[10]蔡仲达,谢尚锦,蔡和杰.老年患者消化道穿孔的临床诊治探讨[J].中国现代普通外科进展,2016,19(12):978-980.
[11]ZBIERSKA K,KENIG J,LASEK A,et al.Differences in the clinical course of acute appendicitis in the elderly in comparison to younger population[J].Pol Przegl Chir,2016,88(3):142.
[12]赵民学,朱琳叶,洪珊,等.单孔腹腔镜阑尾切除术治疗老年急性阑尾炎的疗效[J].中国老年学杂志,2015,35(24):7126-7127.
[13]艾猛,秦立国.腹腔镜治疗老年阑尾炎的临床疗效分析[J].中国医药指南,2016,14(28):52.
[14]包翔宁,陈涛,张宗权.多项指标联合检测在急性阑尾炎诊疗中的价值探讨[J].国际检验医学杂志,2016,37(5):668-670.
[15]GEE M,ADAMS H,JAUNOO S,et al.Hyperbilirubinaemia in appendicitis:the diagnostic value for prediction of appendicitis and appendiceal perforation[J].British J Surg,2015,102(1):229.